Download - New Membership Application Form Bellport Chamber of Commerce PO Box 246 Bellport NY 11713 631-776-9268 www.bellportchamber.com Business Name: Address: Mailing address: Town: Zip: Phone: Fax: Email: Website: Please link website to the Bellport Chamber website Yes No Years in Business: No. of employees: Principal (s): Description of Business: Are you willing to offer a discount to other chamber members on products or services you offer? Yes No If yes, what is the Bellport discount card offer for Members? Are you willing to offer a discount to the general public on products or services you offer? Yes No If yes, what is the Bellport discount card offer for the general public? **Discount Card Notes: Both chamber members and the general public will be expected to produce a Bellport Discount card issued by the Bellport Chamber of Commerce. The card will be differentiated as saying "Bellport Chamber Member" or general. Bellport Chamber Members will each receive 2 cards and the general public 1 card per person. The cards are non-transferable and will have a number and name identified on each. You must agree to offer the discounts listed above until the next Chamber Discount update occurs. Updates are put into place July 1st and January 1st of every year. You may offer one discount or both. What projects/goals would you like the Bellport Chamber of Commerce to work on? May we contact you to help on a committee? Yes No I, the undersigned understand annual dues are to be paid for each year of membership beginning July 1st. We will make every effort to attend scheduled meetings and to support all Chamber events and activities. Signed: Date: Dues: Civic non-profit member - $110 Business Member - $150 Corporate Member       (30 employees or more) - $195 Payment options for your level of membership are available once this form is submitted. Payment may then be made by credit card through the Bellport Chamber paypal account.            OR Mail this form with the appropriate dues to The Bellport Chamber of Commerce, P.O. Box 246, Bellport NY 11713